MEDICARE: KAREN ELIZABETH SCHMALSTIG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	174247	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	177374	OH
3	104100000X	Social Worker	2208511	OH

General Provider Information

NPI Number	:	1790387934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ELIZABETH SCHMALSTIG

Provider Business Mailing Address
First Line	:	5251 LOGAN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-2758
Country	:	US
Telephone Number	:	936-430-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	5251 LOGAN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45431-2758
Country	:	US
Telephone Number	:	936-430-4278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	11/11/2022

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